This paper reviews recent work on trends during this century in societal impacts (direct economic losses and fatalities) in the United States from extreme weather conditions and compares those with trends of associated atmospheric phenomena. Most measures of the economic impacts of weather and climate extremes over the past several decades reveal increasing losses. But trends in most related weather and climate extremes do not show comparable increases with time. This suggests that increasing losses are primarily due to increasing vulnerability arising from a variety of societal changes, including a growing population in higher risk coastal areas and large cities, more property subject to damage, and lifestyle and demographic changes subjecting lives and property to greater exposure. Flood damages and fatalities have generally increased in the last 25 years. While some have speculated that this may be due in part to a corresponding increase in the frequency of heavy rain events, the climate contribution to the observed impacts trends remains to be quantified. There has been a steady increase in hurricane losses. However, when changes in population, inflation, and wealth are considered, there is instead a downward trend. This is consistent with observations of trends in hurricane frequency and intensity. Increasing property losses due to thunderstorm-related phenomena (winds, hail, tornadoes) are explained entirely by changes in societal factors, consistent with the observed trends in the thunderstorm phenomena. Winter storm damages have increased in the last 10-15 years and this appears to be partially due to increases in the frequency of intense nor' easters. There is no evidence of changes in drought-related losses (although data are poor) and no apparent trend in climatic drought frequency. There is also no evidence of changes in the frequency of intense heat or cold waves.